Factors Influencing Medication Adherence In Patients With Epilepsy And Correlation With Anxiety And Depression

Objective The aim was to investigate the factors influencing medication adherence in epilepsy patients and its correlation with anxiety and depression,and to further compare the correlation between structural factors in the evaluation of anxiety and depression and adherence,in order to identify and intervene in the progression of anxiety and depression at an early stage,to improve medication adherence in epilepsy patients,and then to control seizures.Methods 1.The Clinical data of 143 epilepsy patients attending outpatient clinics in Yangzhou University Hospital from September 2020 to August 2022 were consecutively collected,and according to the inclusion and exclusion criteria,patients were screened for inclusion by the Simple Mental State Evaluation Scale(MMSE),and patients with clear cognitive impairment were excluded,and 102 epilepsy patients meeting the criteria were finally included.2.The survey of factors influencing the demographic and clinical characteristics of epilepsy patients enrolled in the group was improved,and their anxiety,depression,compliance,and severity of epilepsy were further assessed using the Hamilton Anxiety Inventory(HAMA),Hamilton Depression Inventory(HAMD),Morisky Medication Adherence Questionnaire(MMAS-8),and National Hospital Seizure Severity Scale(NHS3).3.The relationship between demographic and clinical characteristics of epilepsy patients and the low-moderate adherence group and the high adherence group was analyzed using the rank sum test or chi-square test.Pearson’s chi-square test was used to assess the group differences between HAMA and HAMD scores and adherence scores in the low-moderate adherence group and the high adherence group.4.Spearman correlation analysis was used to assess the relationship between the total HAMA score,the total HAMD score,and the MMAS-8 entries,as well as the relationship between the 2-category factor structure of the HAMA scale,the 7-category factor structure of the HAMD scale,and the MMAS-8 scores.Results 1.A total of 102 patients with epilepsy were included in this study,of whom 22(21.6%)had low medication adherence,42(40.2%)had moderate medication adherence,and 38(38.2%)had high medication adherence.49(48.0%)patients with epilepsy had depression and 53(52.0%)patients with epilepsy had anxiety.the median NHS3 score was 9.5(4,13).2.Among the factors influencing medication adherence in patients with epilepsy,high epilepsy severity significantly decreased patient medication adherence(U=-3.453,P=0.001),while other demographic and clinical characteristics of epilepsy were not significantly different from medication adherence.There was a statistically significant difference in anxiety scores between the low-moderate adherence group and the high adherence group(X~2=33.841,P<0.001),as well as a statistically significant difference in depression scores between the two groups(X~2=31.376,P<0.001).3.The correlation between individual entries in the MMAS-8 and HAMA and HAMD scores in epilepsy patients suggested that HAMA scores and HAMD scores were all significantly negatively correlated with items 1,2,and 8 of the MMAS-8 score(P < 0.05),indicating that increased levels of anxiety and depression make epilepsy patients forgetful and thus score lower in the adherence assessment.In addition,whether or not one perceives that one has difficulty adhering to ASMs was the main significance of item 7 in the MMAS-8,and it was found that HAMA scores were positively correlated with item 7 scores(P = 0.021),indicating that the higher the level of anxiety,the more patients would perceive themselves to be able to adhere to their medication,while HAMD scores were negatively correlated with item 7 scores(P < 0.01),indicating that the higher the level of depression,the more epileptic patients,the more they think they are not able to adhere to their medication.4.The factor structure of the two major categories of HAMA scores,somatic and psychiatric,was significantly and negatively correlated with the compliance scores of epilepsy patients.The correlation was stronger for the somatic factor(r=-0.493)compared to the psychiatric factor(r=-0.478),and epileptic patients with somatic symptoms were more likely to have poor adherence than epileptic patients with psychiatric symptoms.The HAMD score was divided into seven categories of factor structure,with the strongest correlation for the blocking category(r=-0.552),followed by cognitive impairment(r=-0.525),i.e.,the poorer the adherence,the more likely it was that patients with epilepsy had a blocking class presentation,followed by cognitive impairment.Conclusion Severity of epilepsy significantly influenced medication adherence in patients with epilepsy.The prevalence of comorbid anxiety and depressive disorders was higher in patients with epilepsy,and anxiety and depression were significantly associated with poor medication adherence.There may be differences between self-perceived medication use and actual medication use in patients with co-occurring anxiety in epilepsy.Among the structural factors of anxiety and depression evaluation,somatic anxiety and blocking-like depressive manifestations are more strongly correlated with poor adherence,and the presence of somatic anxiety and blocking-like depressive manifestations may serve as early warning factors for early intervention in patients with co-occurring anxiety and depression in epilepsy,thus improving medication adherence in patients with epilepsy.Early identification of anxiety and depression in patients with epilepsy is important for early intervention in their regular medication use to control seizures.